About Fast-Track Cities

Cities bear a large share of the global HIV burden. While offering promise to millions of people, cities are also home to deep, and in some places growing, inequity. In places with large HIV epidemics, the numbers of people living with HIV (PLHIV) in urban areas are so high that effective city-level action is likely to influence national outcomes. Even where an HIV epidemic is smaller, cities are home to large numbers of people belonging to key populations at higher risk of HIV infection but which often receive limited attention in HIV programs. As urban populations continue to rapidly grow, cities will contend with growing HIV epidemics if urgent and effective action is not taken.

The Fast-Track Cities is a global partnership between the City of Paris, International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Human Settlements Programme (UN-Habitat), in collaboration with local, national, regional, and international partners and stakeholders

The initiative was launched on World AIDS Day 2014 in Paris, where mayors from 27 cities in over 50 countries convened to sign the Paris Declaration on Fast-Track Cities a (Paris Declaration) committing to accelerate and scale-up their local AIDS responses. Additional cities have subsequently signed the Paris Declaration (e.g., Mumbai, San Francisco), and negotiations are ongoing to recruit more Fast-Track Cities.

Focused on translating global goals, objectives, and targets into local implementation plans, the FTCI is meant to build upon, strengthen, and leverage existing HIV-specific and -related programs and resources to:

1. Attain 90-90-90 targets

Ensure that at least 90% of PLHIV know their status

Improve access to ART for PLHIV to 90%

Increase to 90% the proportion of PLHIV on ART with undetectable viral load

2. Increase utilization of combination HIV prevention services

3. Reduce to zero the negative impact of stigma and discrimination

4. Establish a common, web-based platform to allow for real-time monitoring of progress

90-90-90 targets and the continuum of care

Fast Track Cities use global and local data to measure progress towards the 90-90-90 and zero stigma and discrimination targets. Program information from the continuum of care--HIV diagnosis to viral suppression-- can be used to determine the 90-90-90 targets.

The 90-90-90 targets are:

Ensure that at least 90% of PLHIV know their status

Improve access to antiretroviral treatment for PLHIV to 90%

Increase to 90% the proportion of PLHIV on ART with undetectable viral load

The 90-90-90 targets provide both a political and programmatic framework for addressing HIV

The 90-90-90 targets focus on the political commitment to build services and support to ensure access to HIV testing for everyone living with HIV. However, diagnosing people with HIV is not enough and the 90-90-90 targets also emphasize ensuring access to early ART and long term viral suppression as a means to keep people healthy and prevent HIV transmission.

The 90-90-90 targets also provide a minimum program target for HIV diagnosis (90% of people living with HIV), access to ART (90% of people diagnosed with HIV) and viral suppression (90% of people on ART virally suppressed). These programmatic targets are derived from earlier modeling work that suggested that voluntary annual HIV testing and immediate ART could eliminate HIV in generalized epidemic settings.

The 90-90-90 programmatic targets are based on experience demonstrating the value of the HIV cascade or continuum of care. The continuum of care includes everything from HIV diagnosis to successful viral suppression. Using this comprehensive framework places responsibility on the program and community to ensure that everyone living with HIV learns their HIV status and accesses treatment. The continuum of care use everyone estimated to have HIV as the denominator when calculating the proportion of people accessing HIV diagnosis, treatment and viral suppression (linkage to care is also included in some continuum). This includes people who may not be aware of their HIV status and/or may or may not be in care or on ART. The comprehensive denominator helps ensure that programs and the community are measuring and evaluating progress for everyone living with HIV and not just those who may be in one clinic or other facility.

The 90-90-90 targets can be determined from the continuum of care and vice versa. To translate the 90-90-90 targets into the programmatic continuum of care framework we use 90% of everyone estimated to have HIV diagnosed (90%*100%), 81% of everyone estimated to have HIV on ART (90%*90%=81%), and 73% of everyone estimated to have HIV virally suppressed (90%*90%*90%=73%). The 90-90-90 targets are a floor and not a ceiling since even when they are reached they translate into 27% of people living with HIV who still have unsuppressed virus—in the end we will likely need to move towards 95-95-95 or even higher targets to ensure access to diagnosis and sustained treatment for everyone.

Current Fast Track Cities

Technical implementation of the FTCI is framed around a five-point strategy that includes:

1) Process and Oversight

2) Program Interventions

3) Monitoring and Evaluation

4) Communications

5) Resource Mobilization

The FTCI Technical Implementation Strategy provides a framework to help Cities consider their existing HIV response strategy and/or develop new strategies. Under local leadership, Fast-Track Cities are uniquely positioned to develop locally designed and led strategies for continuum optimization that respond directly to the needs of vulnerable and key populations within the urban context. Fast Track Cities encourages the development of a city-focused HIV response strategy through the concerted efforts of Mayors, city governments, affected communities, and local health departments. A strong city-focused HIV response strategy with clear objectives can help ensure that HIV services are available for people at risk for and those living with HIV in a rights-based and equitable manner. Please see the Fast Track Cities Technical Implementation Strategy page for more details, examples of City strategies, presentations and other documents

Global FTC Web Portal and City Dashboards

The Global FTC Web Portal is the official home page for Fast Track Cities and provides a platform to learn more about the initiative, monitor progress, and find City-specific information including links to City Dashboards. City Dashboards present the local City-focused Fast Track City response to HIV.

The Fast Track Cities website has been developed by IAPAC in partnership with core partners, city authorities and Dure Technologies (see technical team for more information).

How to use the site

The Fast Track Cities global portal is designed for two audiences:

1) People who would like to know more about HIV, Fast Track Cities and how their city is responding to the HIV epidemic, how to reach local HIV leadership, and where they can get HIV services. The website also showcases efforts to confront HIV in other cities. The site allows people to make contact with other people working on HIV in other cities

2) Public health authorities, managers, clinicians and experts who are interested in Fast Track Cities and learning more about the local and global response to HIV. The dashboard benchmarks and monitors progress towards the 90-90-90 and other targets. It also serves to showcase successful efforts and to also explore successful programs in other cities.

Keeping these two audiences in mind the site is relatively easy to understand and navigate (see Help tab for videos on how to navigate and use the site)). The main site is the Fast Track Cities Global Portal which features a colorful interactive map of the Fast Track Cities. The Global Portal leads to individual City Dashboards that are focused on the local response. Viewers can access the Global Portal from the City Dashboards as well. All of the information is in the public domain and people are encouraged to look at how other cities are responding to the epidemic. The site is meant to grow as the FTCI grows and we welcome your input and contributions.

The interactive maps on the Global Portal and the City Dashboards provide a means to see basic HIV epidemiology combined with mapping of HIV services including community based organizations. Users are encouraged to hover and click on items in the map to further explore the site. The Global portal map allows the viewer to click on the city flags to access the City Dashboards (when available). The menu for the interactive map can be found under the small black menu buttons in the upper corners of the map.

The Global and City Dashboards also feature community voices as well as a comprehensive listing of available HIV services—services can be seen on the map (a click gets you details of the service) and also listed on the HIV services tab. Additionally, many cities have formed FTCI Task Forces and/or other groups that are dedicated to the HIV response. These can be found under their own tab next to the tabs for the health departments and the Mayor’s Office.

The focus of FTCI is to end the AIDS epidemic by 2030 and we have portrayed programmatic and epidemiologic data on the Global and City Dashboards. The counters on the Global Portal represent the projected trends for HIV infections, deaths and other important measures of the epidemic. Data visualization pages represent the latest Global and City-specific data available—hovering over the charts will reveal values. All charts are downloadable by clicking on the small button embedded in the chart area. Data sources and dates are listed along with methods (use hover and click small information icon). City Dashboards portray 90-90-90 counters and Continuum of care counters. Most Cities are missing some of these values—part of the initiative is to help cities collect the data over time—if data is not available then NA is portrayed.

The News tab provides up-to-date news feeds on a variety of topics including FTCI and the Resources page provides links and documents for those who are interested in learning more about HIV, FTCI, 90-90-90, and other topics.

The Cities tab provide a list of all of the Cities for viewers who prefer to navigate to dashboards through a list rather than the map. There is a Search engine for the site and there is also a Translate button that allows the viewer to select from a number of languages.

The above is a short introduction—please do explore the site and visit the Help tab where you will find videos demonstrating some of the exciting features of the FTCI software platform.

Methodology

Technical leadership: The IAPAC technical team leads the development of the website through direct dialogue with local City-led technical team. Information and data in the public domain and available from health departments are assembled and reviewed before posting. The IAPAC technical team assumes responsibility for any errors in the information posted—if you do notice something that needs correction and/or may need updating then please do feel free to contact the technical team.

Sources and data: The data on the site is credible. It is derived from international and local official reports and is reviewed by the IAPAC technical team in consultation with city health experts and core partners. The Global HIV figures are sourced from UNAIDS reports. City epidemiologic and program data is sourced from local city reports or directly from health departments. Poverty and other social determinant data was sourced from credible sites (see sourcing information on website). All data is sourced and dated to allow the viewer to judge the quality and methods of determining the figures. The methodology is available in a hover attached to the counter and/or the figure in question. Some of the data is incomplete and part of the goal of Fast Track Cities is to improve monitoring and evaluation of progress towards the 2020 and 2030 targets.

Figures are downloadable in a variety of formats and will include the sources and dates--see the download button--please do feel free to use them for presentations and publications (we would request that you also reference the site www.Fast-trackcities.org and the access date). HIV services are mapped through internet searches and direct contribution from service providers and/or health departments and/or community members. The HIV services listing is meant to be complete but we recognize that we may have missed some services and/or some services may no longer be offered. If you offer HIV services and would like to be listed please contact the Technical Team. Likewise if you are aware of the closing of a service we would appreciate notification. News and Resources are added on a rolling basis using internet feeds and submissions--we would welcome input on missing news and/or resources.

90-90-90 and cascade: Estimates for people living with HIV and programmatic data needed for calculating progress towards 90-90-90 and an optimal care continuum are sourced from City reports and/or directly from the health department. The methods for calculating these indicators are described in detail elsewhere in the IAPAC Guidelines for Optimizing the HIV Care Continuum (2015). The 90-90-90 methods on the Fast Track Cities dashboards are fixed per international standards which can be seen in the 90-90-90 section. Many cities are still working on determining one or more of the 90-90-90 indicators—where the data is not yet available we present NA. Viral load measurement is often unavailable or only available for a sub-group of people on ART. While preferring viral suppression data for everyone on ART, we use the viral suppression reported even if it is only a sub-group of people on ART which may either over or underestimate the level of suppression. One has to be in care to provide a sample which may over represent people who are adherent and therefore more likely to be virally suppressed. However in many settings viral load tests are requested for those who may be failing and/or non-adherent giving a lower level of suppression. The IAPAC Guidelines for Optimizing the HIV Care Continuum (2015) and WHO guidelines recommend standardized methods for determining the continuum of care. For the Fast Track City dashboards, City continuum of care are presented according to the methods used by the city. This may include the standard indicators of Estimated PLHIV, Number and percentage of estimated PLHIV diagnosed, Number and percentage of PLHIV linked to care (optional), Number and percentage of PLHIV on ART, and Number and percentage of PLHIV virally suppressed. It may also include other non-standard indicators as well. One of the objectives of Fast Track Cities is to improve the ability to monitor the continuum of care and over time the data presented should become increasingly standardized

Stigma and discrimination: Measuring stigma and discrimination is complex and an evolving area. We researched the legal environment for 22 high priority cities for laws that indicate discrimination against people vulnerable for HIV. While poverty and other social determinants are relevant to stigma and discrimination, we focused on laws that directly relate to HIV transmission and/or the marginalization of key populations. We conducted and internet search for the relevant laws and then classified them for the website. When a law existed that potentially increased stigma and discrimination we listed the law on the map with the source to provide viewers the opportunity to review language and make their own determination.

FAQs

What is the Fast Track Cities initiative?

The Fast-Track Cities is a global partnership between the City of Paris, International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Human Settlements Programme (UN-Habitat), in collaboration with local, national, regional, and international partners and stakeholders. It focuses on developing a network of Cities focused on the achieving the commitments in the Paris Declaration including the 90-90-90 targets and reducing stigma and discrimination to zero.

Who are FTC core partners? City of Paris, International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Human Settlements Programme (UN-Habitat)

What is IAPACs role? IAPAC, an international membership organization, was a co-founder of Fast Track Cities and provides political and technical leadership. IAPAC co-organized the initial 2014 Fast Track Cities meeting in Paris as well as supporting and/or co-organizing and/or participating in meetings in Mumbai, Kigali, the White House, and Durban among others. IAPAC is also focused on signing new Cities for the initiative including Kigali, Miami, Oakland, and Kiev among others. IAPAC led the drafting of the Technical Implementation strategy and the development of the Global Web portal and dashboards. Additionally, it has co-authored Cities reports and provided technical guidelines focused on improving the continuum of care.

What is the Paris Declaration? The Paris Declaration is a series of commitments that Cities sign when they join Fast Track Cities. Many more have since signed the Paris Declaration, committing themselves to attaining 90-90-90 targets, as well as zero discrimination and stigma.

What do Mayors commit their cities to do by signing the Paris Declaration on Fast-Track Cities? In addition to the above higher level commitments, Fast-Track Cities agree to work with IAPAC and other partners to implement a five-point implementation strategy .

The Paris Declaration was first signed by 26 cities from around the world on World AIDS Day 2014 in the city of Paris. Many more have since signed the Paris Declaration, committing themselves to attaining 90-90-90 targets (that is 90% of PLHIV aware of their status, 90% of diagnosed PLHIV on ART, and 90% of PLHIV on ART with sustained viral suppression) as well as zero discrimination and stigma. Moreover, as part of the Paris Declaration, Fast-Track Cities commit to seven objectives (from the Paris Declaration):

1. End AIDS as a public health threat in cities by 2030. We commit to rapidly reduce new HIV infections and AIDS-related deaths, including from tuberculosis (TB) and comorbid diseases, including viral hepatitis, putting us on the fast-track to ending AIDS as a public health threat by 2030. We commit to provide sustained access to testing, treatment, and prevention services. We will end stigma and discrimination.

2. Put people at the center of everything we do. We will focus, especially on people who are vulnerable and marginalized. We will respect human rights and leave no one behind. We will act locally and in partnership with our communities to galvanize global support for healthy and resilient societies and for sustainable development.

3. Address the causes of risk, vulnerability and transmission. We will use all means including municipal ordinances and other tools to address factors that make people vulnerable to HIV, and other diseases. We will work closely with communities, service providers, law enforcement and other partners, and with marginalized and vulnerable populations including slum dwellers, displaced people, young women, sex workers, people who use drugs, migrants, men who have sex with men, and transgender people to build and foster tolerance.

4. Use our AIDS response for positive social transformation. Our leadership will leverage innovative social transformation to build societies that are equitable, inclusive, responsive, resilient, and sustainable. We will integrate health and social programs to improve the delivery of services including HIV, tuberculosis, and other diseases. We will use advances in science, technology, and communication to drive this agenda.

5. Build and accelerate an appropriate response to local needs. We will develop and promote services that are innovative, safe, accessible, equitable, and free of stigma and discrimination. We will encourage and foster community leadership and engagement to build demand and to deliver services responsive to local needs.

6. Mobilize resources for integrated public health and development. Investing in the AIDS response, together with a strong commitment to public health, is a sound investment in the future of our cities that fosters productivity, shared prosperity and well-being. We will adapt our city plans and resources for a fast-tracked response. We will develop innovative funding and mobilize additional resources and strategies to end AIDS epidemic as a public health threat by 2030.

7. Unite as leaders. We commit to develop an action plan and join with a network of cities to make the Paris Declaration a reality. Working in broad consultation with everyone concerned, we will regularly measure our results and adjust our responses to be faster, smarter, and more effective. We will support other cities and share our experiences, knowledge, and data about what works and what can be improved. We will report annually on our progress.

What do cities agree to by joining FTC?

The Cities agree to 1) keep open lines of communication regarding Fast Track Cities 2) Engage in a technical handshake with IAPAC 3) Provide local oversight and leadership 4) Report regularly on progress

How are Fast-Track Cities operationalizing their Paris Declaration commitments?

In addition to the above higher level commitments, Fast-Track Cities agreed to work with IAPAC and core partners on the following:

1. Communications: Under the auspices of Mayor’s offices and local health departments, Fast-Track Cities agree to keep an open line of communication with IAPAC regarding their progress, challenges, and opportunities to further accelerate their urban AIDS responses

2. Technical Handshake: Fast-Track Cities agree to support a “technical handshake” to allow for an exchange of technical information as well as epidemiologic, program, and other relevant data. IAPAC provides a City-specific web-based dashboard for each Fast-Track City to map eight simple HIV indicators that will allow cities to report their progress toward attaining the 90-90-90 and zero discrimination and stigma targets, as well as any other HIV/AIDS- or health-specific targets a city may which to map. These city-specific dashboards plug into a global web portal that includes, among other features, a communications platform facilitating inter-city collaboration and exchanges of information.

3. Process and Oversight: As part of their commitment, Fast-Track Cities are expected to convene a task force and/or advisory committee to focus on developing and building consensus around metrics for success and a city-specific action plan to achieve the Fast-Track City objectives. While many cities already have a leadership group in place, IAPAC is making available a technical package that includes template documents, presentations, and guidelines that can assist with attaining the 90-90-90 targets. In select Fast-Track Cities, IAPAC will organize city-specific consultations with local task forces and/or advisory committees in an effort to accelerate the consensus-building and action plan development processes.

4. Report on Progress: It is expected that Fast-Track Cities will report on their progress at least annually; these reports will be aggregated into an annual Fast-Track Cities report. Cities are encouraged to produce quarterly internal reports and make them available to local stakeholders, particularly affected communities. Guidance templates for these reports are provided in the IAPAC technical package. Additionally, Fast-Track Cities are encouraged to share best practices and other case studies with other participating cities.

Are the 2020 and 2030 goals attainable?

Attaining the 2020 and 2030 goals is feasible. The science around HIV control has evolved rapidly and it is now clear that treatment is the most effective means to prevent illness, death and transmission. Achieving the 90-90-90 targets will markedly reduce HIV transmission. Other prevention interventions such as male circumcision, condoms and pre-exposure prophylaxis (PrEP) are also effective and when added to successful treatment coverage promise to further reduce HIV transmission. There has been considerable investment in building the community response and awareness of HIV is increasing alongside efforts to battle stigma and discrimination. Some Cities have nearly achieved the 90-90-90 targets and others will follow by the 2020 deadline. The 2020 targets can be seen as a floor and many Cities will move swiftly towards 2030 goals. However, it is also clear that some Cities will face significant challenges to reach the 2020 targets. Fast Track Cities is designed to help Cities to work together so that no city is left behind.

What are the benefits for cities that elect to become Fast-Track Cities?

There are five main benefits that Fast-Track Cities enjoy as members of a global network:

1. Join a global network to collectively end AIDS as a public health threat by 2030. Joining the Fast-Track Cities network is an opportunity to join the global fight against HIV and to connect with other cities that may be facing similar challenges in accelerating their local AIDS responses. The initiative facilitates formal and informal twinning partnerships and bidirectional technical exchanges between Fast-Track Cities. Additionally, the initiative assists cities in publicizing their success stories locally, nationally, regionally, and internationally – communicating a sense of momentum.

2. Use Fast-Track Cities as a framework for implementation and metrics of success. While many Fast-Track Cities already have a local AIDS strategy and/or their own defined metrics for success, many Fast-Track Cities find it helpful to adopt the FTCI metrics for success as well as augment their strategies with implementation guidance specific to optimizing the HIV care continuum. In some cities, discussions around the added value of the initiative have served to catalyze collective action among local key stakeholders. Having the implementation strategy helps focus discussions around potential collective actions to accelerate the AIDS response in urban settings. In addition, where a Fast-Track City’s health department may need assistance with data generation, analysis, and reporting, IAPAC can provide technical assistance around standardized metrics as outlined in the IAPAC Guidelines for Optimizing the HIV Care Continuum (2015).

3. Receive the Fast-Track Cities technical package. Fast-Track Cities receive an IAPAC technical support package which includes an action plan template and organizational Gantt chart, meeting agenda templates, invitation letter templates, PowerPoint presentations, communications materials, and other proposal templates. Using the IAPAC Guidelines for Optimizing the HIV Care Continuum (2015) as its primary guidance, IAPAC provides capacity-building support through webinars, teleconferences, and on-site consultations for clinical and service providers, community-based organizations, and affected communities. IAPAC and its partners will also facilitate city-to-city technical collaboration on a requested basis through twinning agreements between cities. The IAPAC technical package is meant to leverage, augment, and strengthen ongoing local AIDS efforts

4. Leverage the Fast-Track City web portal and city-specific dashboards. The initiative includes a global web portal with city-specific dash boards that will support both the overall initiative and each of the Fast-Track Cities. The global web portal maps Fast-Track Cities, presents information regarding the initiative, tracks overall progress, and provides a platform for people to engage with Fast-Track Cities. Additionally, the web portal will feature best practice cases and allow for Fast-Track Cities to more easily communicate with other cities to share experiences. Each Fast-Track City is offered a city-specific dashboard which features the city’s AIDS action plan and communicates the city’s progress toward attaining the 90-90-90, zero discrimination and stigma, and other locally set targets. Depending upon data availability, health facilities, basic epidemiology, and program progress is mapped, as well as information for the community about how they can support city-wide efforts.

5. Engage in out-of-the-box financing and resource mobilization. By focusing on attaining the Fast-Track Cities objectives, more efficient use of current local AIDS funding can liberate additional resources to allocate toward HIV care continuum optimization activities. In addition, although joining the global network does not garner direct financial support for Fast-Track Cities, efforts are made to mobilize resources from a variety of sources (e.g., private sector).

What is the FTC dashboard?

Each City has a city-specific dashboard or landing page that can be accessed from the Global Portal and/or directly from the internet or web address. The dashboard contains the latest progress towards 90-90-90 and zero discrimination, resources, news, HIV services and the Fast Track Cities leadership.

What is the Global FTC Web Portal?

The Global FTC Web Portal is the official home page for Fast Track Cities and provides a means to learn more about the initiative, monitor progress, and find City-specific information including links to City dashboards.

Is the data credible?

The data is credible. It is derived from international and local official reports and is reviewed by the IAPAC technical team in consultation with city health experts and core partners. All data is sourced and dated to allow the viewer to judge the quality and methods of determining the figures.

Glossary

90-90-90

A treatment target released by UNAIDS to help end the AIDS epidemic. Specifically the target states: By 2020, 90% of all people living with HIV will know their HIV status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.[1]

Adherence

Closely following (adhering to) a prescribed treatment regimen. This includes taking the correct dose of a drug at the correct time, exactly as prescribed. Failure to properly adhere to a treatment regimen can lead to virologic failure and drug resistance.

AIDS

Acquired immunodeficiency syndrome (AIDS) is a disease of the immune system due to infection with HIV. HIV destroys the CD4 T lymphocytes (CD4 cells) of the immune system, leaving the body vulnerable to life-threatening infections and cancers. AIDS is the most advanced stage of HIV infection. To be diagnosed with AIDS, a person with HIV must have an AIDS-defining condition or have a CD4 count less than 200 cells/mm³ (regardless of whether the person has an AIDS-defining condition).[8]

AIDS Related Deaths

Estimated number of deaths due to AIDS-related causes among people living with HIV

Antiretroviral drug

A medication that interferes with the ability of a retrovirus (such as HIV) to make more copies of itself. There are currently four classes of approved antiretroviral drugs.

Antiretroviral regimen

A strategically sequenced combination of antiretroviral drugs.

ART

Antiretroviral treatment. The daily use of a combination of HIV medicines (called an HIV regimen) to treat HIV infection. A person's initial HIV regimen generally includes three antiretroviral (ARV) drugs from at least two different HIV drug classes.[8]

ART Coverage

Reported number of people on ART as a percentage of estimated people living with HIV (numerator is number of people on ART and the denominator is the number of people estimated to have HIV in the geographic area). This is an important indicator in the continuum of care since it is a measure or program success in ensuring that a maximum number of people are diagnosed with HIV and are on ART. ART is critical for epidemic control since it prevents HIV and TB illness, death and transmission.

CD4 cells

An infection-fighting white blood cell that HIV infects and kills, leading to a weakened immune system. The number of CD4 cells in a sample of blood is an indicator of the health of the immune system

CD4 count

A measurement of the number of CD4 cells in a sample of blood, reported as the number of CD4 cells per cubic millimeter (or cells/mm3) of blood plasma. A CD4 count is used by doctors to determine when to begin, interrupt, or halt antiretroviral therapy; when to give preventive treatment for opportunistic infections; and to measure response to treatment. A normal CD4 count is between 500 cells/mm3 and 1,400 cells/mm3.

CDC

Centers for Disease Control and Prevention (CDC) is a federal agency that protects the health and safety of people at home and abroad through health promotion; prevention and control of disease, injury, and disability; public health workforce development and training; and preparedness for new health threats.[8]

Civil Society Organizations (CSOs)

Non-governmental and not-for-profit organizations that have a presence in public life, expressing the interests and values of their members or others, based on ethical, cultural, political, scientific, religious or philanthropic considerations. This includes: community groups, non-governmental organizations (NGOs), labor unions, indigenous groups, charitable organizations, faith-based organizations, professional associations, and foundations.[2]

Co-infection

When a person has two or more pathogens (virus, bacteria, fungus, protozoa, helminth, prion, etc.) at the same time. For example, a person infected with HIV may be coinfected with hepatitis C (HCV) or M. tuberculosis or both. TB can be confusing since co-infection is sometimes used for both the bacteria M. tuberculosis and TB the disease caused by M. tubercuosis.[8]

Co-morbidity

When a person has two or more diseases or conditions at the same time. For example, a person with high blood pressure may also have heart disease.[8]

Cross resistance

Occurs when a micro-organism has changed (mutated) in such a way that it loses its susceptibility to multiple drugs simultaneously. For example, drug resistance to one non-nucleoside reverse transcriptase inhibitor (NNRTI) usually produces resistance to the entire NNRTI drug class

Drug interaction

An effect that can occur when one drug is taken with another drug or when the drug is taken with particular foods. Possible effects include changes in absorption from the digestive tract, changes in the rate of the drug's breakdown in the liver, new or increased side effects, or changes in the drug's activity.

Drug resistance

Drug-resistant HIV

"Virus that is resistant to one or more antiretroviral drugs that would typically work well against HIV.

Entry inhibitor

A class of antiretroviral drugs designed to disrupt the ability of HIV to enter a CD4 cell through its surface.

Fast-Track Cities

Cities that are formally part of the Fast-Track Cities Initiatve. Cities generally join the Fast-Track Cities Initiative when the mayor signs the Paris Declaration. [9]

Fast-Track Cities Initiative

The Fast-Track Cities initiative (FTCI) is a global partnership between the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Human Settlements Programme (UN-Habitat), and the City of Paris, in collaboration with local, national, regional, and international implementing and technical partners. The initiative's aim is to build upon, strengthen, and leverage existing HIV programs and resources in order to accelerate locally coordinated, city-wide responses to end AIDS as a public health threat by 2030.[3]

FTCI Technical Implementation Strategy

A technical guide for fast-track cities to use in organizing their HIV response focused around a 5-point strategy including: process and oversight, program interventions, monitoring and evaluation, communications, and resource mobilization. [3]

Genotypic test

A test that determines if HIV is resistant to particular antiretroviral drugs. The test analyzes a sample of the virus from an individual's blood to identify any genetic mutations that are associated with resistance to specific drugs

HBV Infection

Infection with the hepatitis B virus (HBV). HBV can be transmitted through blood, semen, or other body fluids during sex or injection-drug use. Because HIV and HBV share the same modes of transmission, people infected with HIV are often also coinfected with HBV. HBV infection progresses more rapidly in people coinfected with HIV than in people infected with HBV alone.[8]

HCV infection

Infection with the hepatitis C virus (HCV). HCV is usually transmitted through blood and rarely through other body fluids, such as semen. HCV infection progresses more rapidly in people coinfected with HIV than in people infected with HCV alone.[8]

HIV

The virus that causes AIDS, which is the most advanced stage of HIV infection. HIV is a retrovirus that occurs as two types: HIV-1 and HIV-2. Both types are transmitted through direct contact with HIV-infected body fluids, such as blood, semen, and genital secretions, or from an HIV-infected mother to her child during pregnancy, birth, or breastfeeding (through breast milk).[8]

HIV Care Continuum

A model that outlines the sequential steps or stages of HIV medical care that people living with HIV go through from initial diagnosis to achieving the goal of viral suppression (a very low level of HIV in the body), and shows the proportion of individuals living with HIV who are engaged at each stage. Stages include: Diagnosed with HIV; linked to care; prescribed antiretroviral therapy; achieved viral suppression. [10]

HIV cohort

A group of people who share a particular characteristic, for example, age or a medical condition. Participants for a clinical trial may be recruited from a particular cohort, such as pregnant women, children under 5 years old, or men infected with HIV. Successful HIV programmes have the ability to follow cohorts of people diagnosed with HIV and in care over time.[8]

HIV Criminalization

The use of criminal law to penalize alleged, perceived or potential HIV exposure; alleged nondisclosure of a known HIV-positive status prior to sexual contact (including acts that do not risk HIV transmission); or non-intentional HIV transmission. [4]

HIV/AIDS-related stigma is a complex concept that refers to prejudice, discounting, discrediting and discrimination directed at persons perceived to have AIDS or HIV, as well as their partners, friends, families and communities.[5]

IAPAC Guidelines

Released in September 2013, The IAPAC Guidelines feature 36 evidence-based recommendations meant to support the global attainment of the UN 90-90-90 and Zero Discrimination targets. [6]

Immune system

The collection of cells and organs whose role is to protect the body from foreign invaders, including bacteria, parasites, and viruses.

Incidence

The number of new cases of a condition, symptom, death, or injury that develops in a specific area during a specific time period.[8]

A not-for-profit organization representing more than 27,000 clinicians and allied healthcare professionals in over 150 countries. Its mission is to improve the quality of HIV prevention, care, treatment, and support services provided to men, women, and children affected by and living with HIV and comorbid conditions such as tuberculosis (TB) and viral hepatitis through advocacy, education, capacity-building, research, and technical assistance activities. IAPAC's broad global portfolio of activities is spearheaded by an international staff comprised of clinicians, public health specialists, quantitative and qualitative research specialists, and experts in the field of continuing medical education.[3]

Joint United Nations Programme on HIV/AIDS (UNAIDS)

Provides advocacy leadership regarding its vision of zero new HIV infections, zero discrimination, and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations - United Nations High Commission for Human Rights (UNHCR), United Nations Children's Fund (UNICEF), World Food Program (WFP), United Nations Development Program (UNDP), United Nations Population Fund (UNFPA), United Nations Office on Drugs and Crime (UNODC), UN Women, International Labor Organization (ILO), United Nations Education, Scientific, and Cultural Organization (UNESCO), World Health Organization (WHO), and the World Bank.[3]

Mutation

A change or adaptation that can be passed down to future generations. Mutations can occur only when a virus is actively multiplying, and not when antiretroviral drugs have suppressed the viral load to undetectable. If HIV replication is not well controlled, an individual's original HIV strain can adapt to infect different cell types or resist different antiretroviral drugs.

New HIV Infections

Estimated number of people newly infected with HIV in a given time frame.

Non-nucleoside reverse transcriptase inhibitor (or NNRTI)

A class of antiretroviral drugs that bind to and disable HIV's reverse transcriptase enzyme, a protein that HIV needs to make more copies of itself. Without functional reverse transcriptase, HIV replication is halted. Current NNRTI medications are only effective against HIV-1. Also called "non-nukes."

Nucleoside reverse transcriptase inhibitor (or NRTI)

A class of antiretroviral drug. Nucleoside analogues are faulty versions of the building blocks necessary for HIV reproduction. When HIV's reverse transcriptase enzyme, a protein that HIV needs to make more copies of itself, uses a nucleoside analogue instead of a normal nucleoside, reproduction of the virus's genetic material is halted. Also called "nukes."

Paris Declaration

The Paris Declaration on Fast-Track Cities is signed by Mayors to formally join their city into the Fast-Track Cities Initiative and commit them to accelerate and scale-up their local AIDS responses.

People Living with HIV (PLHIV)

Infants, children, adolescents, and adults infected with HIV.

Phenotypic test

A laboratory test that determines by direct experiment whether a particular strain of HIV is resistant to antiretroviral drugs.

PMTCT

Prevention of Mother to Child Prevention. Strategies used to prevent the spread (transmission) of HIV from an HIV-infected mother to her child during pregnancy, during labor and delivery, or by breastfeeding (through breast milk). Strategies include antiretroviral (ARV) prophylaxis for the mother during pregnancy and labor and delivery, scheduled cesarean delivery, ARV prophylaxis for the newborn infant, and avoidance of breastfeeding.[8]

Post-Exposure Prophylaxis (PEP)

Short-term treatment started as soon as possible after high-risk exposure to an infectious agent, such as HIV, hepatitis B virus (HBV), or hepatitis C virus (HCV). The purpose of post-exposure prophylaxis (PEP) is to reduce the risk of infection. An example of a high-risk exposure is exposure to an infectious agent as the result of unprotected sex.[8]

Pre-Exposure Prophylaxis (PrEP)

An HIV prevention method for people who are HIV negative and at high risk of HIV infection. Pre-exposure prophylaxis (PrEP) involves taking a specific combination of HIV medicines daily. PrEP is even more effective when it is combined with condoms and other prevention tools.[8]

President's Emergency Plan for AIDS Relief (PEPFAR)

The U.S. government global initiative to combat the HIV/AIDS epidemic. The President's Emergency Plan for AIDS Relief (PEPFAR) works with governmental and non-governmental partners worldwide to support integrated HIV prevention, treatment, and care programs. PEPFAR places emphasis on improving health outcomes, increasing program sustainability and integration, and strengthening health systems.[8]

Prevalence

The number or proportion of people with a particular disease or condition in a given population and at a specific time.[8]

Protease inhibitor (or PI)

A class of antiretroviral drug that prevents replication of HIV by disabling HIV's protease enzyme. Without HIV protease, the virus cannot make more copies of itself.

Resistance testing

A laboratory test to determine if an individual's HIV strain is resistant to any antiretroviral drugs. There are currently two such tests - genotypic and phenotypic testing.

Seroprevalence

The overall occurrence of a disease or condition within a defined population at one time, as measured by blood tests (serologic tests).[8]

Side Effects

The actions or effects of a drug (or vaccine) other than desired medication effects. The term usually refers to undesired or negative effects, such as headache, skin irritation, or liver damage.

Surveillance estimate

The use of surveillance data to determine estimated indicators. For example, surveillance data can be used to estimate number of people living with HIV, ART coverage, number of PLHIV virally suppressed, number of new HIV infections, or number of AIDS-related deaths. UNAIDS uses data from surveys and clinic settings to derive surveillance estimates using the Spectrum model.

Treatment as Prevention (TasP)

The use of antiretroviral drugs (ARVs), used to treat HIV, as a method to reduce HIV and TB illnes, death and transmission. ART, if given early enough, can prevent illness and lead to a near normal life-span. ART reduces the individual risk of TB by around 65% among people living with HIV. ARVs work to decrease the amount of HIV virus in the body (viral load), studies have shown that a lower viral load reduces the risk of passing HIV to sexual partners (nearly 100%), to fetuses and children (nearly 100%), and probably for people who share needles while injecting drugs (difficult to quantify).[11]

Tuburculosis

An infection caused by the bacteria Mycobacterium tuberculosis. Tuberculosis (TB) is spread when a person with an active infection (TB disease) coughs, sneezes, speaks, or sings, and then a person nearby breathes in the bacteria. TB usually affects the lungs, but it can also affect other parts of the body, such as the kidneys, spine, and brain. There are two forms of TB: latent TB infection and TB disease. In people with HIV, TB is considered an AIDS-defining condition. ART reduces the risk of TB by around 65% for people living with HIV. When isoniazid preventive treatment is added this risk reduction can be estimated to be above 90%.[8]

Undetectable (viral load

The point at which levels of HIV's genetic material (or RNA) in the blood are too low to be detected with a viral load test. This does not mean that the virus has stopped replicating or has been removed from the body entirely, only that the small amount of virus remaining is below the viral load test's ability to measure it.

United Nations Human Settlements Programme (UN-Habitat)

The United Nations agency working on sustainable urban development with the mandate of promoting adequate housing and improved livelihoods in urban settings by harnessing the opportunities that urbanization offers. UN-Habitat's priorities are focused on urban governance, economies, legislation, planning, risk reduction, and research. Among its city-specific initiatives are the City Prosperity Initiative, City Resilience Profiling Initiative, and Cities and Climate Change Initiative.[3]

Viral Load

The amount of HIV in a sample of blood. Viral load (VL) is reported as the number of HIV RNA copies per milliliter of blood. An important goal of antiretroviral therapy (ART) is to suppress a person's VL to an undetectable level—a level too low for the virus to be detected by a VL test.[8]

Viral Suppression

When antiretroviral therapy (ART) reduces a person's viral load (HIV RNA) to an undetectable level. Viral suppression does not mean a person is cured; HIV still remains in the body. If ART is discontinued, the person's viral load will likely return to a detectable level. Viral suppresison is usually defined as
<1000 viral copies per microliter but sometimes this threshold can be lowered to 50.[8]

Virologic failure

Inability of antiretroviral therapy to reduce the viral load or to maintain suppression of HIV.

WHO

World Health Organization is the agency of the United Nations that provides global leadership on health-related matters. Responsibilities of the World Health Organization (WHO) include shaping the global health research agenda, setting health standards, promoting evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends.[8]

WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection (2016)

Released in June 2016, these guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care.[7]